Search

This article describes the provision of stroke services in Greece and addresses the possible effects of the hospital rotation system. Unique to Greece is a centrally administered rotation system for hospital 24-hour on-call systems in the major cities. This means that a hospital may admit new patients only during specific 24-hour periods every 3 to 5 days. All Greek city hospitals must conform to this rotation basis for emergency and scheduled admissions. Patients with stroke arrive to designated rotation on-call hospital via ambulance or taxi or by private means and are first seen in the accident and emergency department where they are given priority attention accordingly and allocated to a neurology ward, medical ward, or stroke bay if the hospital has one. Occasionally, a neurosurgical consultation is sought; the patient may be admitted directly to a neurosurgery ward. Some attempts have been made to reach a degree of specialization in stroke bays, but with only a few of these, situated only in major cities, the vast majority of patients are still admitted to neurology or medical wards. Nurses and physicians in Greece continue to strive to improve outcomes for their patients with stroke despite adverse circumstances.

Purpose of Review: Resource-challenged environments of low and middle-income countries face a significant burden of neurocritical illness. This review attempts to elaborate on the multiple barriers to delivering neurocritical care in these settings and the possible solutions to overcome such barriers., Recent Findings: Epidemiology of neurocritical illness appears to have changed over time in low and middle-income countries. In addition to neuro-infection, noncommunicable neurological illnesses like stroke, traumatic brain injury, and traumatic spinal cord injury pose a significant neurocritical burden in resource-limited settings. Many barriers that exist hinder effective delivery of neurocritical care in resource-challenged environments. Very little information exists about the neurocritical care capacity. Research and publications are few. Intensive care unit beds and trained personnel are significantly lacking. Awareness about the risk factors of preventable conditions, including stroke, is lacking. Prehospital care and trauma systems are poorly developed. There should be attempts to leverage neurocritical care in these settings with focus on promoting research, local training, capacity building, preventive measures like vaccination, raising awareness, and developing prehospital care., Summary: Considering the disease burden and potentials to improve outcome, attempts should be made to develop neurocritical care in resource-challenged environments., Video Abstract: http://links.lww.com/COCC/A11.

Health care in the USA is undergoing a drastic transformation under the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act is driving major health-care policy changes by connecting payment for traditional health-care services to value-based care initiatives and emphasising population health and innovative mechanisms to deliver care. Under the Patient Protection and Affordable Care Act, neurological practice will need to adapt and transform. Therefore, neurological policy should consider employing a new framework for neurological residency training, developing interdisciplinary team approaches to neurological subspecialty care, and strengthening the primary care-neurological specialty care interface to avoid redundancies and other medical waste. Additionally, neurological policy will need to support a more robust review of diagnostic and care pathway use to reduce avoidable expenditures, and test and implement bundled payments for key neurological diagnoses. In view of an anticipated 19% shortage of US neurologists in the next 10 years, development of new neurological policy under the Patient Protection and Affordable Care Act is paramount., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Academic neurology is undergoing transformational changes. The public investment in biomedical research and clinical care is enormous and there is a growing perception that the return on this huge investment is insufficient. Hospitals, departments, and individual neurologists should expect more scrutiny as information about their quality of care and financial relationships with industry are increasingly reported to the public. There are unprecedented changes occurring in the financing and delivery of health care and research that will have profound impact on the mission and operation of academic departments of neurology. With the passage of the Patient Protection and Affordable Care Act (PPACA) there will be increasing emphasis on research that demonstrates value and includes the patient's perspective. Here we review neurological investigations of our clinical and research enterprises that focus on quality of care and comparative effectiveness, including cost-effectiveness. By highlighting progress made and the challenges that lie ahead, we hope to create a clinical, educational, and research roadmap for academic departments of neurology to thrive in today's increasingly regulated environment., (Copyright © 2011 American Neurological Association.)

Appropriate assessments for medical techniques of clinical diagnostic examination have been one of long-standing issues in social insurance system in Japan. Assessments of those in the surgical fields in which the most of assessments are evaluated by surgical operations including related materials as well as surgeons' techniques, is rather easy to evaluate quantitatively. Comparing with this, medical fields including neurology, quantitative assessments of medical techniques either diagnostic or treatment is not so easy. In order to evaluate the burden in each technique in the medical fields, several research and surveillance have been performed. In terms of 'duration' of the medical techniques, there have been several date in favor of long duration techniques are evaluated as to be worth to cost higher. However, these data were criticized for the reasons of ignorance of patients' opinion such as satisfaction to the diagnosis and treatments. However, in neurological fields, "the neurological examination techniques" which has a consensus of taking long duration in each patient, was able to be evaluated as an independent item in medical social insurance system in 2008, albeit it is not as technique but as laboratory examination. Towards establishment of the economical basis for medical care, Japanese Neurological Association should have another identity of artisans' union as well as academic union.

Background: There is poor access to neurology services for patients in the community., Aim: To describe the training of GPs with special interest (GPwSI) in headache and the setting up of a GPwSI clinic in general practice, and report on a comparison with the existing neurology service in terms of case severity, patient satisfaction, and cost., Design of Study: New service provision and evaluation by a questionnaire survey., Setting: General practice and hospital neurology service in inner-city London., Method: The intervention involved training GPs as GPwSIs and setting up a GP headache service. A questionnaire survey was conducted, measuring headache impact, satisfaction, and cost estimates., Results: Headache impact was not significantly different between the two groups of patients, referred to hospital and to a GPwSI. Patients were significantly more satisfied with the GPwSI service, particularly that the service was effective in helping to relieve their symptoms (89% versus 76%; adjusted odds ratio=7.7; 95% confidence interval=2.7 to 22.4). The cost per first appointment was estimated to be pound sterling 136, with pound sterling 68 for subsequent contacts. These are lower than costs for neurologist contacts., Conclusion: GPwSI services can satisfy the needs of patients with similar headache impact at costs that are lower than those for secondary care services.

The "Cost of Disorders of the Brain in Europe" (CBDE) study was conducted by the European Brain Council (EBC) to estimate prevalence and cost of the twelve leading disorders encountered in Neurology, Neurosurgery, and Psychiatry. The data for Ireland are presented here. Prevalence and costing information was obtained by structured review of published literature for each country. Where such information was lacking, figures were estimated from European data. Costs included direct medical, direct non-medical, and indirect costs. None of the costs presented here are directly from Irish data and the prevalence figures are mostly estimated from known European rates. In 2004, 1.1 million people in Ireland were affected by a disorder of the brain. Total cost of included disorders in Ireland was 3.0 billion Euro, representing 3% of gross national product, and costing each Irish citizen Euro 775 per year. Brain disorders are prevalent and pose significant economic burden in Ireland.

Since the seventies the growing of sanitary expenses has become the first worry for our authorities and the seeking of solutions has brought the presence of economists to solve the health problems. Therefore the health economy studies the production and distribution of health and sanitary attention in two senses: one like a discipline (usually located in universities and publications in the area of economy) and another one to the resolution of health problems and care, favouring interdisciplinary cooperation and its application to management. When speaking about the relation ship between economy and health, it is necessary to consider three areas: first that of basic concepts in economy: demand, offer, elasticity, market faults and state intervention in economy. The second aspect goes to the specific characteristics of sanitary care from economic perspective and the application of economic concepts to health field. And finally the third one is the field of the most important techniques of economic evaluation for sanitary programs and the analysis of sanitary systems reforms in some countries.